Incorporating SDH into Pediatric Clinical Settings

Laura Gottlieb, MD, MPH

Laura Gottlieb, MD, MPH, UCSF Center for Health and Community

Is it feasible to routinely screen and intervene around social factors in clinical

settings?

• Patients have no objection to being asked about their social and environmental conditions in health care settings (whether primary or urgent care);

• Many social determinants can be actionable and this doesn’t have to interfere with clinical care;

• Electronic screening likely results in higher disclosure of social needs.

Bay Area Regional Help Desk Consortium (bayareahelpdesks.org)

All patients

Referral to Social Work, Medical Legal Partnership or other professional -tier services.

Navigator interventions using desk resources, technology and algorithms.

Standardized social & environmental needs screening.

Patients with resource

needs

Patients with complex needs

What is a Help Desk?

Warm

Hand-offs &

Culturally Responsive Care

Help Desk Model

Pediatric Help Desk RCT at SFGH and CHO

• Randomized controlled trial with cluster design (by day of the week)

• Control group families still receiving more than “standard of care”

• Outcomes– Process indicators: Impact on prioritized social needs;

benefits access– Intermediate indicators: Impact on food security,

caregiver satisfaction with health care services, subjective social status ladder

– Longer-term indicators: Impact on child health, health care services utilization

Preliminary Results (Six weeks)

Completely resolved Partially resolved0.0

10.0

20.0

30.0

40.0

50.0

60.0

39.0

54.0

% of families with resolution one or more top rated needs

• Subjective social status

• Parent-reported child health

Preliminary Results (Four months)

Scaling and Dissemination: Barriers and Opportunities

• Evidence• Funding• Lay workforce• Professional silos • Regional work• Technology

iScreen Study

VS

iScreen Study

Methods

• Consenting caregivers in Children’s Oakland ED2 randomly assigned intervention (tablet-based social survey with optional audio assist in English and Spanish) or control (in-person survey) group;

• Fully bilingual/bicultural Latina research assistants;• Respondents answered questions about health-related

social factors (including IPV and substance use in addition to basic material needs).

Integrating SDH into EHRs

IOM Committee on Recommended Social and Behavioral Domains and Measures for Electronic Health Records

Integrating SDH into EHRs*Note: Not all categories/domains represented in table

Category* Domain* Reviewed and not selected*

Socio-demographics Sexual orientation Gender identity

Race/ethnicity

Country of origin

Education

Financial resource strain

Employment

Behavioral Diet/physical activity Abuse of other substances

Nicotine use/exposure Sexual practices

Alcohol use Cognitive function in late level, positive psychological fxn

Individual-Level Social Relationships

Social connections/isolation Social support, work conditions, hx of incarceration

Neighborhoods/Communities Socioeconomic characteristics Environmental exposures

Race/ethnic characteristics Neighborhood resources

Questions?